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. Pulmonary vein isolation (PVI) by antral circumferential   ablation is the standard procedure for patients with symptomatic and   drug-refractory paroxysmal atrial fibrillation (AF). In some patients   addition of ganglionated plexi (GP) modification in anatomic locations to PVI   confers significantly better outcomes than PVI alone. Case report. We   reported a patient with paroxysmal, symptomatic AF and severe bradycardia a   month prior to ablation. The patient was treated with antiarrhythmic drugs   without success. Because of severe bradicardia the patient was implanted with   a temporary pace maker two days before PVI. During PVI the decision was made   to also do a modification of the left GP. Three months after the procedure   the patients was in stable sinus rhythm without any symptoms. Conclusion. In   selected patients with paroxysmal AF and pronounced vagal response PVI by   circumferential antral ablation combined with GP modification during single   ablation procedure can produce higher success rates than PVI or GP ablation   alone

Pulmonary veins isolation in a patient with atrial fibrillation and pronounced vagal response: Is it enough?